The dental sensitivity appears due to different factors: loss of enamel, gingival recession or iatrogenic factors, so its diagnosis requires a detailed clinical history, a clinical examination and certain specific tests to rule out other oral problems. Its treatment combines preventive measures with professional treatments adapted according to the cause and intensity of the discomfort.
Definition and pathophysiology of tooth sensitivity
Tooth sensitivity is a localized, brief, stabbing pain caused by the exposure of dentin, a vital and permeable tissue formed by collagen and hydroxyapatite, which is exposed. This is traversed by dentinal tubules containing fluid and prolongations of odontoblastic cells, connecting the tissue with the dental pulp, where myelinated A-δ type nerve fibers are found, responsible for transmitting pain rapidly.
When tooth enamel or root cementum wears away, the dentinal tubules become open and permeable, allowing externalallowing external stimuli to displace the liquid inside them. This movement activates the pulpal mechanoreceptors, causing the characteristic sensation of tooth sensitivity, according to Brännström's hydrodynamic theory.
The intensity of the painful response depends on the diameter of the dentinal tubules, the length of the exposed ones, the degree of root exposure or enamel loss, as well as the pulp condition and the presence of inflammation.
| Type of stimulus | Description |
| Mechanics | Contact with dental instruments, such as probes. |
| Chemicals | Exposure to acids present in food or beverages. |
| Thermal | Temperature changes, mainly cold. |
| Osmotics | Ingestion of sugars or sweet foods. |
| Evaporative | Direct air or suction cannula during clinical procedures. |
Etiology and risk factors
Tooth sensitivity is most common in adults between 20 and 50 years of age, with a peak around 30-40 years of age. It has an estimated prevalence of 11.5% in the in the general population. The causes of exposure are multiple, ranging from enamel loss and gingival recession to iatrogenic factors in some cases.
1. Loss of enamel
Tooth enamel can wear away for various reasons: attrition, abrasion and erosion.
| Atrition | Mechanical wear due to tooth-to-tooth contact. It can be physiological due to chewing or pathological in cases of bruxism, dental malposition or occlusal alterations. |
| Abrasion | Pathological loss due to external agents, such as brushing with horizontal movements that affect the amelocemental junction, or acquired habits: eating pipes or playing wind instruments, among others. |
| Erosion | Chemical loss without bacterial intervention. It may be due to environmental, dietary or drug exposure., and/or gastric. |
Gingival recession
Gingival recession exposes the root surfaces, exposing dentin and cementum.exposing the dentin and cementum. The most common causes are gingivitis or periodontitis, surgical or conservative periodontal treatments, tooth movements resulting from orthodontic treatments, natural aging and aggressive brushing causing wedge-shaped defects.
3. Iatrogenic factors
Some dental procedures can induce tooth sensitivity, such as the preparation of restorations or crowns where a lot of tooth tissue must be removed, periodontal treatments or tooth whitening. The tooth whitening can generate transient sensitivity due to the passage of hydrogen peroxide or carbamide through the enamel and dentin to the pulp, osmotic changes, dehydration, alterations in intradental pressure and pH changes. It usually disappears within 24 hours after remineralization of dentin with fluoride compounds.
Clinical diagnosis of tooth sensitivity
For diagnose tooth sensitivity it is necessary to follow a systematic process that includes: clinical history, oral examination and specific tests.
Step 1. Medical history
It is important to to collect information about the patient's symptoms, oral hygiene, possible related medical and dental history, diet and habits.
| Symptoms | Pain intensity, frequency, where it is located and what triggers it. |
| Oral hygiene | How to brush, type of toothpaste and brush. |
| Background | Recent treatments, general illnesses, digestive problems. |
| Diet | Frequent consumption of soft drinks, citrus fruits, vinegar or alcohol. |
| Habits | Bruxism, use of wind instruments, smoking. |
Step 2. Clinical examination
During the clinical examination, the teeth are checked for the exposure of the teeth and their wearThe examination will also check for gum recession, defective restorations or signs of pulp inflammation.
| Exposed teeth | Areas without enamel or with uncovered cement. |
| Gum recession | Measure how much they have retracted. |
| Dental wear | Whether attrition, abrasion or erosion. |
| Restorations | Defects in crowns or fillings: leaking, fractured or misaligned. |
| Pulpal inflammation | Color change, bleeding or prolonged sensitivity. |
Step 3. Diagnostic tests
Diagnostic tests are necessary to rule out caries, pulpitis or fissures., whose symptoms could be confused with tooth sensitivity.
| Thermal stimulation | Application of cold air or cold water to evaluate painful response. |
| Tactile stimulation | Use of dental probe on the exposed dentin surface. |
| Chemical test | Application of mild acid solutions to reproduce dentin pain. |
| Radiography | To rule out deep caries, fractures or pulp problems. |
Management and treatment of tooth sensitivity
It is advisable to take preventive measures to prevent tooth sensitivity from appearing and, if it does, choose a treatment that addresses the underlying cause and symptomatic relief.
Preventive measures
Preventive measures include soft brushing of teeth no more than twice a day with specific products for tooth sensitivity to help reduce discomfort. At Laboratorios KIN we offer the SensiKINrange, specially formulated for the care of sensitive teeth. In addition to its toothpaste and Mouthwash presentations, the line includes formats such as spray and oral gel, ideal for oral hygiene in cases of localized hypersensitivity.
Professional treatment
There are different options to relieve sensitivity and protect dentin:
| Topical desensitizers | Pastes or gels with fluoride, potassium nitrate or calcium phosphate that promote dentinal tubule obliteration. |
| Sealants and resins | Coating of exposed dentin to protect the pulp. |
| Periodontal therapies | Connective tissue grafts to cover exposed roots. |
| Correction of parafunctional habits | Occlusal splints for bruxism. |
| Erosion and abrasion management | Restoration of affected teeth with composite or ceramic materials, maintaining function and esthetics. |
In tooth whitening treatments, if the patient presents previous sensitivity, it is recommended to apply desensitizing gel or paste before and after the procedure, adjust the frequency and duration of the treatment to minimize discomfort, as well as informing the patient about the possibility of temporary discomfort and the techniques to alleviate it.
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